It has become a tradition for me in this blog to post some reflections in the last posting of each year. This year is no different, and this posting is the end of 2014 installment.
Each year there has been a theme to my annual reflections. As the start of this blog was very much tied to the Health Information Technology for Clinical and Economic Health (HITECH) Act, the theme of 2009 concerned the deteriorating economy and its impact on the Oregon Health & Science University (OHSU) informatics program, the American Recovery and Reinvestment Act (ARRA), and the HITECH Act within ARRA. In 2010, I focused on the rolling out of the HITECH Act, especially the workforce development grants that were to become a major part of my work life in the following years. In 2011, I described the implementation of our HITECH workforce grants. By 2012, the beginning of the end for the HITECH funding was at hand, while in 2013, I described the transition from HITECH funding and a number of new developments, including the Informatics Discovery Lab (IDL) at OHSU and the rollout of the clinical informatics subspecialty.
What is the theme for 2014? One thing for certain is that work and life have gone on without HITECH. There were many great new accomplishments for the myself and the OHSU informatics program this past year, such as achieving Accreditation Council for Graduate Medical Education (ACGME) accreditation for our new clinical informatics fellowship that will be launched in 2015, new grants from the National Institutes of Health (NIH) Big Data to Knowledge (BD2K) program, and a new focus on competencies for medical (and other health professional) students in clinical informatics.
Despite the grants of HITECH becoming a distant memory, the impact of the HITECH Act on the informatics field cannot be understated. Of course the meaningful use program is still moving along, even if Stage 2 has been daunting and the prospect of penalties for not meeting meaningful use become a possible reality. But the informatics world is truly a different place now than before the HITECH Act. The road has been rocky, but EHR adoption has become near-universal in US hospitals and very substantial in physician offices. The fact that we are now lamenting about the problems of data and its lack of interoperability demonstrates progress in our lamenting less than a decade ago about healthcare being too paper-based. Much has been written about HITECH, often with a tinge (sometimes more) of politics thrown in. My thoughts resonate most with those who view HITECH in the context of its origins and acknowledge its success and limitations, such as Robert Wachter and John Halamka.
What lies ahead for 2015? Certainly the work described above that we have undertaken in 2014 will continue to play an important role. And like in all years, indeed in my whole career, there will be opportunities that emerge out of nowhere and turn out to be major activities.
Wednesday, December 31, 2014
Friday, December 12, 2014
Education in Informatics: Distinct Yet Integrative
One of the challenges we face in informatics education is how to call out its knowledge, skills, and competencies in the larger context of health and biomedicine. In other words, how do teach its important contributions while recognizing informatics does not exist in a solitary vacuum?
I see this at all levels of education in which I am involved, from that of medical and other health professional students to those training for professional careers in informatics.
One example of this is seen in medical student education. The importance of informatics in the training of physicians is finally being seen as important, yet the challenge is how to integrate appropriate informatics education into an environment where the evolution of the curriculum has been away from discrete courses to integration of all topics, typically organized into blocks and sometimes further divided into cases (i.e., case-based learning). Just as medical education no longer has standalone courses in biochemistry, pathology, physical examination and so forth, we should not aspire to have any sort of standalone informatics course either. Not only is informatics best learned in the context of solving real problems in clinical medicine, it also needs to be seen as integrated with the other subjects being learned.
The same applies to other healthcare professions. We must find ways to make informatics knowledge, skills, and competencies important, yet also integrated with their primary role as deliverers of healthcare.
Even for those training to work in informatics professionally, it is still important to understand its context. Some may be informatics professionals in clinical settings, public health settings, research settings, and even consumer-focused settings. The skilled informatician must know how to add value to those settings by best applying informatics.
This issue also plays out in one of the concerns I have for clinical informatics fellowships. As I have written before, I am troubled the idea of a standalone, one-size-fits-all, two-years-on-the-ground fellowship that is required by ACGME rules. Two additional years of fellowship is a lot to ask of physicians who do not start meaningful earning until into their 30s or later. Several of my clinical faculty colleagues at OHSU have asked why fellows cannot train simultaneously in informatics and another discipline. Not only do I not object to such integrated training, I actually believe it would be a great boon for an oncologist, cardiologist, surgeon, etc. to simultaneously train in informatics along with his or her other discipline, especially if they plan to pursue informatics in the context of that discipline.
But all this integration of informatics aside, I still strongly assert the title of this posting, which is that informatics should be distinct with its knowledge, skills, and competencies. However, its training and practice should be appropriately integrated with other health, clinical, and biomedical aspects of where it is being applied.
I see this at all levels of education in which I am involved, from that of medical and other health professional students to those training for professional careers in informatics.
One example of this is seen in medical student education. The importance of informatics in the training of physicians is finally being seen as important, yet the challenge is how to integrate appropriate informatics education into an environment where the evolution of the curriculum has been away from discrete courses to integration of all topics, typically organized into blocks and sometimes further divided into cases (i.e., case-based learning). Just as medical education no longer has standalone courses in biochemistry, pathology, physical examination and so forth, we should not aspire to have any sort of standalone informatics course either. Not only is informatics best learned in the context of solving real problems in clinical medicine, it also needs to be seen as integrated with the other subjects being learned.
The same applies to other healthcare professions. We must find ways to make informatics knowledge, skills, and competencies important, yet also integrated with their primary role as deliverers of healthcare.
Even for those training to work in informatics professionally, it is still important to understand its context. Some may be informatics professionals in clinical settings, public health settings, research settings, and even consumer-focused settings. The skilled informatician must know how to add value to those settings by best applying informatics.
This issue also plays out in one of the concerns I have for clinical informatics fellowships. As I have written before, I am troubled the idea of a standalone, one-size-fits-all, two-years-on-the-ground fellowship that is required by ACGME rules. Two additional years of fellowship is a lot to ask of physicians who do not start meaningful earning until into their 30s or later. Several of my clinical faculty colleagues at OHSU have asked why fellows cannot train simultaneously in informatics and another discipline. Not only do I not object to such integrated training, I actually believe it would be a great boon for an oncologist, cardiologist, surgeon, etc. to simultaneously train in informatics along with his or her other discipline, especially if they plan to pursue informatics in the context of that discipline.
But all this integration of informatics aside, I still strongly assert the title of this posting, which is that informatics should be distinct with its knowledge, skills, and competencies. However, its training and practice should be appropriately integrated with other health, clinical, and biomedical aspects of where it is being applied.
Wednesday, December 10, 2014
Accolades for the Informatics Professor - Fall, 2014 Update
As always, I am pleased to share periodically with readers the various accolades and mentions that colleagues, projects, and I at Oregon Health & Science University (OHSU) have received in recent months. This posting covers the mentions in the latter half of 2014.
In the late summer was a mention of my role in the American Medical Association (AMA) Accelerating Change in Medical Education Program of grants to medical schools to advance change in medical education. The OHSU grant has a component of informatics, with a focus on teaching 21st century physicians about data that they will use to facilitate their practices and others will use to assess the quality of care they deliver. One article focused on our development of competencies in clinical informatics for medical students, while the other described how we are implementing them in our AMA grant project.
OHSU also received a mention in a Web page purporting to rank the Top 25 "healthcare informatics" programs by "affordability". I am not sure exactly how they get their cost figures, but the page does accurately describe our program (number 16 on their list).
I received some other mentions concerning the new clinical informatics subspecialty, one in an article just before this year's board exam as well as in an interview with Stanford Program Director, Dr. Chris Longhurst.
Of course, the new subspecialty is one of many changes that informatics education has undergone recently, as noted both in an article I wrote as well as in one where I was interviewed.
I gave a number of talks that were recorded this fall, including my kick-off of our weekly OHSU informatics conference series as well as a talk about our Informatics Discovery Lab at the 2nd Annual Ignite Health event in Portland. The latter has an interesting format of five minutes to talk with slides that automatically advance every 15 seconds (for a total of 20 slides). The talk on the IDL led to my being invited to moderate a panel on business opportunities in health information technology in Portland.
There was also some press around the new National Institutes of Health (NIH) Big Data to Knowledge (BD2K) grants we received. Related to Big Data, another magazine called out my blog posting from last year that data scientists must also understand general research methodology.
Another news item mentioned a project I am likely to write about more in the future that concerns OHSU establishing collaborations in informatics and other areas in Thailand.
Finally, a few accolades came from events of the AMIA Annual Symposium 2014. One was getting my picture in HISTalk in a mention of the Fun Run at this year's symposium. I was also interviewed by a reporter who wanted to follow up on why I selected them items that I did for my top ten events of the year in my Year in Review talk. It was nice to be able to elaborate some and also watch the tweeting that followed.
It is gratifying to receive these accolades and of course I know have to keep doing innovative and important work to maintain them.
In the late summer was a mention of my role in the American Medical Association (AMA) Accelerating Change in Medical Education Program of grants to medical schools to advance change in medical education. The OHSU grant has a component of informatics, with a focus on teaching 21st century physicians about data that they will use to facilitate their practices and others will use to assess the quality of care they deliver. One article focused on our development of competencies in clinical informatics for medical students, while the other described how we are implementing them in our AMA grant project.
OHSU also received a mention in a Web page purporting to rank the Top 25 "healthcare informatics" programs by "affordability". I am not sure exactly how they get their cost figures, but the page does accurately describe our program (number 16 on their list).
I received some other mentions concerning the new clinical informatics subspecialty, one in an article just before this year's board exam as well as in an interview with Stanford Program Director, Dr. Chris Longhurst.
Of course, the new subspecialty is one of many changes that informatics education has undergone recently, as noted both in an article I wrote as well as in one where I was interviewed.
I gave a number of talks that were recorded this fall, including my kick-off of our weekly OHSU informatics conference series as well as a talk about our Informatics Discovery Lab at the 2nd Annual Ignite Health event in Portland. The latter has an interesting format of five minutes to talk with slides that automatically advance every 15 seconds (for a total of 20 slides). The talk on the IDL led to my being invited to moderate a panel on business opportunities in health information technology in Portland.
There was also some press around the new National Institutes of Health (NIH) Big Data to Knowledge (BD2K) grants we received. Related to Big Data, another magazine called out my blog posting from last year that data scientists must also understand general research methodology.
Another news item mentioned a project I am likely to write about more in the future that concerns OHSU establishing collaborations in informatics and other areas in Thailand.
Finally, a few accolades came from events of the AMIA Annual Symposium 2014. One was getting my picture in HISTalk in a mention of the Fun Run at this year's symposium. I was also interviewed by a reporter who wanted to follow up on why I selected them items that I did for my top ten events of the year in my Year in Review talk. It was nice to be able to elaborate some and also watch the tweeting that followed.
It is gratifying to receive these accolades and of course I know have to keep doing innovative and important work to maintain them.
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